H10.811 — Pingueculitis, right eye
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Interpretation and formal report must accompany the photographic study.
- Clinical documentation in the medical record supporting the need for photographic documentation of medical progress.
Key Coverage Criteria
- External ocular photography is medically necessary to track progression of external ocular conditions affecting the external eye, eyelids, and ocular adnexa.
- Keratitis, corneal degeneration, dystrophy, injury, edema, ulceration, opacification, ectasia, or perforation
- Iridocyclitis and associated glaucoma
- Anterior chamber inflammation, hyphema, narrow angle, or synechiae
- Conjunctivitis, episcleritis, or scleritis
- Eyelid pathology (e.g., blepharitis, dermatitis, entropion, ectropion, ptosis, retraction, xanthelasma, chloasma, madarosis, edema, vascular abnormalities)
1 Active Policy
AMBETTER-CP.VP.43 — External Ocular Photography
Related Codes
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